Ophthalmology and Optometry Coding Alert

There are only two new procedure codes for ophthalmologists in CPT 1999. One is 67220, for laser destruction of a choroid lesion. The other is 92135, for diagnostic laser scanning.

Here is the descriptor for 67220: Destruction of localized lesion of choroid (e.g., choroidal neovascularization), one or more sessions, photocoagulation (laser).

The new code is important to the surgeons who use it because it represents more accurately what they are doing. It also represents a higher work value, and therefore, more money. Before, they had to use 67210 (destruction of localized lesion of retina). The new code distinguishes the choroid from the retina.

The procedure is more complicated than 67210, says Joseph C. Noreika, MD, representative to the AMA CPT Advisory Board for the American Society of Cataract and Refractive Surgery. In the byzantine business of assigning a value to a code, we have to consider things like skill and risk, says Noreika, who practices in Medina, OH. 67220 requires greater skill and involves higher risk than 67210, he says. Therefore, the new code has a higher relative value. (This code would usually be used by retina sub-specialists, not general ophthalmologists, says Noreika.)

This new code is better because it distinguishes between choroidal and retinal work, says Connie Ripley, billing and insurance clerk for the Charles Retina Institute, a five-provider center in Memphis, TN.

New Scanning Laser Code

The other new code, 92135, goes along with a relatively new machine, which has been on the market for about three years. The descriptor is Scanning computerized ophthalmic diagnostic imaging (e.g., scanning laser) with interpretation and report, unilateral. Until now, the procedure hasnt been widely used, since there was no code for it.

Before you can get reimbursement, you have to have a code, says Noreika. Now that there is a code (92135) and an RVU (0.87), this will be used much more. Economic remuneration will spur the dissemination of the technology, says Noreika.

The scanning laser will have a much wider application than 67220, says Noreika. But will ophthalmologists go out and buy the machine before they know whether Medicare -- or other carriers -- will pay for the procedure? Quite possibly, says Noreika. Doctors adopt technology because it works.

At the Charles Retina Institute, the physicians have been using the scanning laser for some time, even though there hasnt been a code for it.